LLM-Assisted Emergency Triage Benchmark: Bridging Hospital-Rich and MCI-Like Field Simulation

Abstract

Research on emergency and mass casualty incident (MCI) triage has been limited by the absence of openly usable, reproducible benchmarks. Yet these scenarios demand rapid identification of the patients most in need, where accurate deterioration prediction can guide timely interventions. While the MIMIC-IV-ED database is openly available to credentialed researchers, transforming it into a triage-focused benchmark requires extensive preprocessing, feature harmonization, and schema alignment -- barriers that restrict accessibility to only highly technical users. We address these gaps by first introducing an open, LLM-assisted emergency triage benchmark for deterioration prediction (ICU transfer, in-hospital mortality). The benchmark then defines two regimes: (i) a hospital-rich setting with vitals, labs, notes, chief complaints, and structured observations, and (ii) an MCI-like field simulation limited to vitals, observations, and notes. Large language models (LLMs) contributed directly to dataset construction by (i) harmonizing noisy fields such as AVPU and breathing devices, (ii) prioritizing clinically relevant vitals and labs, and (iii) guiding schema alignment and efficient merging of disparate tables. We further provide baseline models and SHAP-based interpretability analyses, illustrating predictive gaps between regimes and the features most critical for triage. Together, these contributions make triage prediction research more reproducible and accessible -- a step toward dataset democratization in clinical AI.